HomeMy WebLinkAboutBLD1632 Mobile Home - BLD Permit / Conditions - 3/21/1975 Chapler, Mary L. #1632
P. 0. Box 682 3-21-75
Be I f a i r, Wa. 98529
Riverhill - 1st road on left to end of rd.
Mobile Home
or
or BUILDING PERMIT APPLICATION
MASON COUNTY
P. O. Box 400 Shelton, Washinqton 98584
D
DAT E_ o
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/ �J �� ( W9 q360
PERMIT NO.__l� a n
Applicant to complete numbered spaces on y.
JOB ADD/R}E55
1 LEGAL
ESCR. jWf ( SEE ATTACHED SHEET)
OWNER MAIL ADDRESS It_1P PHONE
/ a r �� l,Un U s
S-
CONTRACTJfR V MAIL ADDRESS '+ PHONE LICENSE NO.
3 (�' i-t." , L 3 7 tJ lJ�•�r S? 7 7�
ARCH CT OR DESIGNER MAIL AODRE55 PHONE LICENSE NO.
4
ENGINEER MAIL ADDRESS PHONE LICENSE NO.
5
LENDER MAIL ADDRE55 BRANCH
6
USE OF BUILDING
7
Cf YV«—
8 Class of work: XNEw ❑ ADDITION ❑ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
9 Describe work:
10 Change of use from
Change of use to '
11 Valuation of work: $ /��pQ O
PLAN CHECK FEE PERMIT FEE
SPECIAL CONDITIONS: Type of Occupancy
Const. /L/ Group Division
Size of Bldg. N0.of Max.
(Total) Sq. Ft. Stories Occ. Load
Fire Use Fire Sprinklers
APIP I ATION ACCEPTED BY PLANS CHECKED BY APPROVED FOR ANCE BY, Zone `� Zone Required Dyes ❑No
No. of OFFSTREET PARKING SPACES:
"'— C✓ Dwelling Units Covered Uncovered
N O T I C E Special Approvals Required Received Not Required
ZO N I N C,•
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, S
HEATING, VENTILATING OR AIR CONDITIONING. HEALTH DEPT. J J
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION FIRE DEPT.
AUTHORIZED IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUC- OTHER (Soecify)
TION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF
120 DAYS AT ANY TIME AFTER WORK IS COMMENCED.
I hereby certify that I have read and examined this application and
know the same to be true and correct. All provisions of laws and
ordinances governing this type of work will be complied with whether
specified herein or not. The granting of a permit does not presume to
give authority to violate or cancel the provisions of any other state or
local law regulating construction or the performance of construction.
SIGNATURE OF CONTRACTOR OR AUTHORIZEDENT (DATE)
I GNATU RE OWNER II OWNE ILDER D TE)
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
SHGLTON PRINTING CO.
PLOT PLAN
� 2 i! 20
FADDRESS'je.'Q , ; n (� �d ��/ G(yr PERMIT NO.
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DESCRIPTION LOT �,� �� �{�� BLIP /y �{I WiVIA lflex f� /1rs-J.- f e�
SITE AREA Sq. Ft. AREA OF SITE OCCUPIED BY BUILDINGS Sq. Ft.
INSTRUCTIONS TO APPLICANT
THIS FORM NEED NOT BE USED WHEN PLOT PLANS DRAWN TO SCALE OF NOT LESS THAN 1"=20' ARE
FILED WITH PERMIT APPLICATION. (EACH BUILDING SITE MUST HAVE A SEPARATE PLOT PLAN.)
FOR NEW BUILDINGS PROVIDE THE FOLLOWING INFORMATION IN THE SPACE BELOW: LOCATION OF
PROPOSED CONSTRUCTION AND EXISTING IMPROVEMENTS.SHOW BUILDING,SITE,AND SETBACK DIMEN-
SIONS. SHOW EASEMENTS, FINISH CONTOURS OR DRAINAGE, FIRST FLOOR ELEVATION, STREET ELEVA-
TION Al"D SEWER SERVICE ELEVATION, SHOW LOCATION OF WATER, SEWER, GAS AND ELECTRICAL
SERVICE LINES.SHOW LOCATION OF SURVEY PINS.SPECIFY THE USE OF EACH BUILDING AND MAJOR POR-
TION THEREOF.
0 INDICATE NORTH IN CIRCLE GRAPH SQUARES ARE 5' X 5' OR 1"=20'
I/We certify that the proposed construction will conform to the dimensions and uses shown above and that no changes will be made without
first obtaining approval.
14
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NAME Of OWNER ) OF SITE STRUCTURE(S) (PRINT) IG ATUR F NER( OR A HORIZED REPRESENTATIVE
DO NOT WRITE BELOW THIS L NE
APPROVED
DISTRICT AS NOTED DATE �ZI '7,s-